Post-Hospital Falls Among the Older Population: The Temporal Pattern in Risk and Healthcare Burden

Journal of the American Medical Directors Association. Oct;24(10):1478-1483.e2. 2023
Qian X.X., Chau P.H.*, Fong D.Y.T., Ho M., Woo J.

Abstract

Objectives: Older adults are prone to falls following hospital discharge, resulting in healthcare utilization and costs. The fall risk might change over time after discharge. To fill research gaps in this area, this study examined the temporal pattern in incidence and healthcare burden of post-hospital falls in older adults.

Design: A territory-wide retrospective cohort study was conducted.

Setting and participants: Participants were Hong Kong adults aged ≥65 years and discharged from hospitals between January 2007 and December 2017.

Methods: The participants were followed for 12 months to identify fall-related inpatient episodes, accident and emergency department (AED) visits, and mortality after discharge. The post-hospital falls were further analyzed in 2 subcategories (1) only requiring AED visits and (2) requiring hospitalization. The incidence rate and faller incidence proportion for total falls and subcategories during the different periods were examined. The corresponding healthcare utilization and costs were calculated.

Results: Among the 606,392 older adults discharged from hospitals during the study period, 28,593 individuals (4.7%) experienced at least 1 post-hospital fall within 12 months, resulting in a total of 33,158 falls (57 per 1000 person-years). Out of post-hospital falls presenting to hospitals, one-third only required AED visits, and two-thirds required hospitalization. The fall incidence rate peaked in the first 3 weeks after discharge and gradually decreased to a stable level from the fourth to ninth week. The annual healthcare costs related to post-hospital falls exceeded USD 28.9 million in older adults, with the mean cost per faller and fall being USD 11,129 and USD 9596.

Conclusions and implications: The fall-related healthcare utilizations after discharge impose a substantial economic burden on older adults. During the first 9 weeks, particularly the first 3 weeks, older adults were at high risk of falling. The efforts on resource allocation for fall prevention are suggested to prioritize this period.

Keywords: Post-hospital; falls; healthcare burden; older adults; temporal pattern.

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(*Corresponding Author)